Patient presents with Polysubstance Use Disorder, characterized by a problematic pattern of concurrent use of multiple substances leading to clinically significant impairment or distress.  The patient reports regular use of alcohol, cannabis, and prescription opioids (hydrocodone) for over 12 months, meeting DSM-5 criteria for Polysubstance Dependence.  Symptoms include tolerance, withdrawal symptoms upon cessation (e.g., tremors, anxiety, insomnia), cravings, and continued use despite negative consequences such as relationship problems, job loss, and financial difficulties.  Patient acknowledges a strong desire to reduce substance use and expresses motivation for treatment.  Mental status examination reveals mild psychomotor agitation and anxious mood.  Physical examination reveals no acute medical issues.  Diagnosis of Polysubstance Use Disorder is confirmed based on patient self-report, clinical interview, and collateral information.  Differential diagnoses considered include mood disorder and anxiety disorder.  Treatment plan includes referral to substance abuse counseling, cognitive behavioral therapy (CBT) for relapse prevention, and motivational interviewing.  Pharmacological interventions will be considered based on ongoing assessment and progress.  Patient education provided on risks associated with polysubstance abuse, harm reduction strategies, and community resources.  Follow-up appointment scheduled in two weeks to monitor progress and adjust treatment plan as needed.  ICD-10 code F19.20 (Polysubstance dependence, unspecified) is assigned.  Patient advised to seek immediate medical attention for severe withdrawal symptoms or suicidal ideation.